Bad Medicine

The rumors had been swirling around Miami's AIDS community for at least two years: Dr. Homer L. Kirkpatrick, Jr., would do more for his patients than just treat their HIV infections. But the allegations of sexual misconduct seemed too outrageous to believe. Yet even after some patients began discussing in AIDS support groups their troubling encounters with Dr. Kirkpatrick, no one took action. Those who later stepped forward confessed that months passed before they could stop blaming themselves. Others had to be coaxed by friends into speaking with investigators.

Last week, after completing interviews with more than a dozen witnesses, including at least five alleged victims, a Miami-based investigator with the Florida Agency for Health Care Administration filed a request for an emergency order to suspend Kirkpatrick's license to practice medicine. The investigator declines to discuss the case or even acknowledge its existence, noting that his department's policy is to refrain from comment about ongoing investigations. However, sources familiar with the probe say the request for an emergency order will likely be acted upon this week.

(Repeated attempts to contact Dr. Kirkpatrick directly for comment regarding this article proved unsuccessful. His Miami attorney, Mark A. Dresnick, was asked to forward to Kirkpatrick a series of written questions. Citing the confidentiality of investigations conducted by the Agency for Health Care Administration, Dresnick declined to cooperate or to confirm the existence of any investigation.)

One of the former patients interviewed by the state investigator agreed to describe to New Times his experiences with Kirkpatrick on condition that his true name not be used. For the purposes of this article, he shall be called Jordan. He is 39 years old, a husband and father, and a former drug user, which is how he suspects he contracted HIV, the virus believed to cause AIDS.

Jordan was referred to Kirkpatrick by a nursing assistant, and began seeing the doctor in 1991 at his Miami clinic on SW 37th Avenue. After several visits, Jordan says, he began to trust Kirkpatrick. They established a pattern: "Every examination would be a touching of the lymph nodes, sticking the tongue out, smiling, laughing, joking, and the examination, you know, of the rectal." Jordan winces at that last recollection.

The jokes about masturbation didn't bother him so much, Jordan allows, but he thought something was not quite right with the rectal examinations; the doctor would linger over them and ask Jordan if he felt sexually aroused. His concerns about Kirkpatrick's behavior increased dramatically in late 1992, after he was admitted to Mercy Hospital in Coconut Grove, where the doctor was a staff member. During Jordan's stay at the hospital, Kirkpatrick paid him a late-night visit. "He told me he needed some sperm," Jordan says, "and he left the cup on top of the table and then he came back. I honestly, deep down in my heart, I really honestly believed that I had to give that sperm A you know, for whatever reason it was, my prostate or whatever. I was so into trying to get the help I needed that I went on to try and put myself mentally in the position where I was having sex with my wife. And I couldn't. I couldn't. I couldn't do it.

"He came back into the room," Jordan continues, "and put his hands on me and started telling me, 'Just think about anything.' And he said, 'Think of your wife.' So I did, and he ejaculated me off."

After recalling the incident at a friend's office in Little Havana, Jordan pauses and takes a deep breath. "He let that stuff come all over my stomach, and that's what really pissed me off," he says. "Because then I said, 'How are you going to take it from my stomach? How are you going to put it in a cup?' And he says, 'I got something for it,' and he went and washed his hands. And I'm just lying there with the stuff on top of my stomach.

"He came back with a swab. He did like that," Jordan recounts, making a perfunctory wiping motion with his hand. "Just like nothing had happened. I mean, I mean, I didn't want to do any of those things, you know?"

Despite his misgivings, Jordan continued to see Kirkpatrick. This past June he was admitted to the Miami Heart Institute in Miami Beach for coronary surgery to alleviate a problem created by his earlier drug use. While still in the recovery room, he says, Kirkpatrick paid a visit. "I remember it was about 11:30, 12:00 that evening," Jordan recalls, tears welling in his eyes at the memory. "I woke up to find him under the bed sheet. And he was doing oral sex to me. I pushed him away and he went to the bathroom, sprayed something in his mouth, and turned around. He came back like nothing had happened."

Lying in his hospital bed, connected to an intravenous tube and still shocked by what had just happened, Jordan says he listened warily as Kirkpatrick promised to obtain for him immune globulin, an experimental and very expensive drug that some AIDS practitioners believe strengthens the immune system. In a seemingly unrelated aside, the doctor also talked about participating in a program that rewarded schoolchildren for good behavior. "I remember him telling me that he had just come from a benefit somewhere down south," says Jordan, "and that he had rewarded a lot of kids that evening. Right there I put two and two together." If he acquiesced to the doctor's sexual advances, Jordan concluded, he'd get the help he needed, including access to experimental drugs.

Unwilling to be bribed or perhaps blackmailed, Jordan set about looking for another doctor. But his association with Kirkpatrick haunted him. For one thing, other AIDS doctors quizzed him about why he was leaving Kirkpatrick's care, and their questions hinted at some underlying suspicion. Jordan responded by claiming he and Kirkpatrick suffered a conflict of personalities. Despite that assertion, one doctor asked if he had read a certain article in an AIDS newsletter. Flustered, Jordan recalls replying, "Look, I haven't read any magazine. I'm here to get followup."

The "article" in question had appeared in the July issue of a newsletter published by the People With AIDS Coalition (PWAC), Dade's largest AIDS advocacy organization. Tucked away on the bottom of page six, amid stories about research grants, clinical trials, and new AIDS programs, was a startling item about an unnamed AIDS doctor. The headline: "Dear Doctor Scumbag -- -- Festering Pimple on the Face of the Medical Community Gets Popped."

"You know who you are," began the unsigned, four-paragraph open letter. "The one sexually abusing your patients. We have numerous complaints against you, however no one yet wants to have his name made public. Yet.

"Don't pretend you don't know who we're addressing. It's you -- the one who excessively fondles patients while making obscene suggestions, the one who masturbates his clients while giving a rectal exam, the one who tells his patient that he should masturbate more often. What kind of disgusting pleasure do you get out of intimidating those in need who come to you in trust?

"We will find one who will come forward to have his story told, and we have people to substantiate it. The AIDS community knows who you are. People are talking. Your patients are talking. Your sick little secret is out. Just how long did you think you could keep this repugnant activity quiet?"

The doctor's name was not divulged in the open letter, or in an article in the newsletter's next issue. J.D. Ramsay, managing editor of PWAC's newsletter and author of the open letter, refuses to identify "Doctor Scumbag" by name; doing so, he fears, could lead to legal action. (A Miami Police Department spokesman last month confirmed that Homer L. Kirkpatrick, Jr., a specialist in internal medicine, is the man referred to as Doctor Scumbag. "The Miami Police Department is investigating certain allegations against Dr. Kirkpatrick," said spokesman Ray Lang, who would not elaborate beyond pointing to "alleged sexual improprieties" that may have occurred during physical examinations. "We have interviewed several of his patients and taken statements from those patients. It's going to be up to the State Attorney's Office to determine if there are any charges filed." The department subsequently halted its investigation while the investigator for the Agency for Health Care Administration, Luis Collado, pursued the case.)

PWAC's Ramsay says he decided to print the allegations after three men came to the organization's Biscayne Boulevard office in May and June asking for help. None wanted to go public, however, leaving the People With AIDS Coalition in a quandary. "When the situation was described to me, it nauseated me," Ramsay recalls. "I sat down and said, 'How can I burn this into the public consciousness?' I've been accused of yellow journalism for that article. My retort to that is, 'How can you know that [this] is happening and not say anything?'" Ramsay hoped the message in his newsletter, which has a circulation of about 7000 and is closely read in the AIDS community, would prompt more patients to come forward. He got the response he wanted.

The second article was published in the August newsletter, this one a signed editorial by PWAC's president, Charles LaMar Hutchison. It was headlined "The Success That Made Me Sad." According to Hutchison, the coalition received an additional fourteen complaints following publication of the July open letter. "The case histories are infuriatingly similar," Hutchison wrote. "This is not a subject for sensationalism, but for extreme compassion and sensitivity, and one which the Coalition is trying to handle extremely confidentially. We do not want the victim who may decide to come forward to feel as if he has to fear the further embarrassment of unwanted publicity and prying into his personal life unless it is his decision to 'go public.'

"We at the Coalition completely empathize with how hard it is to overcome the abject shame of this kind of victimization, but without someone being strong enough, caring enough, yes, brave enough to come forward, it will continue to happen.

"I have been saddened to know that other [AIDS patients], social workers, case managers, AIDS service organizations, and even other physicians have known about these crimes, in some cases for years, and have -- for whatever reasons -- done nothing to stop this abhorrent, criminal situation."

Tony Diez-Tome, a clerk at the nonprofit organization Cure AIDS Now, admits he is one of those people who heard the stories but did nothing. Some of the doctor's patients were his friends, he says. When they told Diez-Tome about their experiences with the doctor, he urged them to file charges. "I just freaked," he recalls. "I said, 'Why don't you go forward?' And they said, 'No, I'd rather not.' You have to respect their decision."

According to Diez-Tome, among the reasons for his friends' reluctance is the fact that "Doctor Scumbag" is one of just a few doctors in Miami who welcome AIDS patients who lack private insurance and are covered only by Medicaid or Medicare. Rather than complain to authorities, the alleged victims began bringing friends with them to the examining room as a safeguard. "He's a very good doctor," Diez-Tome asserts. "He's one of the leading physicians in the HIV field."

That sentiment has been echoed by other doctors, social workers, and activists, many of whom praise Kirkpatrick's medical skills and devotion to indigent patients. But at the same time they condemn his other alleged actions. One social worker who requested anonymity explains that even after hearing rumors, he continued referring clients to Kirkpatrick. "There are a lot of people being cared for by the doctor, and there are not a lot of doctors who do what he does," says the social worker. "I'm appreciative of many of the things he does." Not all patients felt victimized, he adds. "Some patients were okay with it, because they haven't been able to ejaculate as a result of the disease."

Dr. Patrick Cadigan, a North Miami Beach physician who has treated several of Kirkpatrick's former patients, says some of them have told him they "enjoyed" their experiences. "They said it was the best sex they ever had. They had the whole mystique about being in a doctor's office," Cadigan reports, clearly distressed by the accounts. "It's disgraceful. It's deplorable. Every person at Mercy Hospital knew about it and never said a thing.... I feel as bad for him as I do for the patients. He's a sick man; he needs treatment just as much as the patients do."

Although some patients may not have been offended by Kirkpatrick's sexual advances, Cadigan speculates that others endured because they had no private insurance and viewed their only other alternative, Jackson Memorial Hospital, as impersonal and unappealing. He describes their attitude this way: "Yeah, he likes to touch my penis, but I'll put up with it."

One of Kirkpatrick's former patients, who wishes to be identified only as Max, was among those who "put up with it," at least until he finally concluded the doctor's behavior was abusive. Max says it took him months to deal with the shame. Nearly a year after his last visit with Kirkpatrick, he still feels uncomfortable describing the doctor's method of examining him. "Let's just say it was sexual battery," he states. The experience left him with an abiding suspicion of physicians. "That's the worst part about it," he confides. "You don't feel comfortable going to a doctor. I keep the door open and I sit on a chair."

A graduate of the University of Miami School of Medicine, the 53-year-old Kirkpatrick spent sixteen years practicing medicine with a group of physicians in Little Havana before opening his own one-man clinic in 1990. According to court documents, the move coincided with the collapse of his personal finances.

Together with his wife, Sandra A. Kirkpatrick, a registered nurse, Kirkpatrick filed for bankruptcy on December 19, 1989. In court papers, the couple listed $1.2 million in debts and $964,000 in assets, including two horses, a 1982 BMW, six fur coats, a house in Coral Gables, and ownership interests in two duplexes.

A reorganization plan filed with the court eleven months later detailed how Kirkpatrick hoped to emerge from bankruptcy by more than doubling his clinic's revenues in three years, to $550,000 annually. Though the proposal drew a skeptical response from the U.S. Attorney's Office, Kirkpatrick was allowed to proceed, and by this past July he had succeeded in fully retiring his debts. Kirkpatrick accomplished this by taking on a very heavy patient load and by selling his clinic to BMB Management, which in turn hired him as a salaried employee and the clinic's sole physician.

One former clinic staff member says Kirkpatrick began scheduling patient appointments about fifteen minutes apart, roughly 30 people per day. (In a sworn deposition given in May of this year, Kirkpatrick estimated treating 2000 AIDS patients since 1988.) The strain caused by such intensity, she believes, may have adversely affected his judgment. But she also believes he maintained a semblance of self-awareness. "I just think he saw this whole thing coming," she says, referring to his alleged misconduct and the investigation that followed. "He started getting stranger. He wouldn't answer his pages. We couldn't get hold of him."

Although the office staff reportedly had heard about the allegations and was aware of their publication in the PWAC newsletter, the former clinic employee says she found it difficult to reconcile the image of "Doctor Scumbag" with the compassionate family man she knew. Kirkpatrick, she says, was handsome, well dressed, and gregarious. His wife also worked in the clinic, and his three daughters, ages ten, fourteen, and seventeen, frequently visited their parents at work. "Did he want to help these people?" she asks in regard to his patients. "I think so. He was a sick person, but there was kindness there. He'd come up to me [and point out a particular patient]. He'd say, 'Don't charge him. He can't pay.' He never turned anyone away."

The former employee and other sources say that soon after the first PWAC article was published in July, a state investigator visited Kirkpatrick's office and asked to see his records. According to the former employee, BMB Management, the company that now owned the clinic and employed Kirkpatrick, expressed alarm.

Further complicating matters, a lawsuit accusing Kirkpatrick of malpractice was due to be heard in August. Vernelle Lowder had tested positive for HIV before becoming Kirkpatrick's patient in December 1991. Even though the Florida Department of Health and Rehabilitative Services A not Kirkpatrick A had made the faulty diagnosis, Lowder argued that during the ten months she was his patient, Kirkpatrick should have realized she exhibited none of the symptoms associated with AIDS. On the eve of trial, Kirkpatrick settled the case out of court and agreed to pay Lowder $250,000.

Kirkpatrick left town for vacation after settling with Lowder. While he was gone, he was fired from his position at the clinic. Shortly thereafter he also resigned his staff privileges at Mercy Hospital. "Mercy Hospital learned of the allegations about Dr. Kirkpatrick in August," asserts Mercy president Edward J. Rosasco. "When we questioned him about these allegations, Dr. Kirkpatrick resigned."

According to clinic staffers, Kirkpatrick then abruptly packed up his family and moved to Virginia. "He never faced anyone," an employee says sadly. "He never said anything to any of us."

If the emergency order suspending his license is approved by the Tallahassee office of the recently created Agency for Health Care Administration, Kirkpatrick can request an immediate hearing and ask the courts to overturn the order. But regardless of whether the doctor challenges the order, the case will be considered by a special panel from the Florida Board of Medicine to determine if there is probable cause to file a formal complaint. If the complaint is sustained, the Board of Medicine can assess penalties ranging from probation and a fine to permanent revocation of his license to practice medicine in Florida. (Health Care Administration investigators routinely report suspected criminal behavior to their local State Attorney's Office. A spokeswoman for the Dade State Attorney's Office declined comment.)

Former patient Jordan hopes for some form of disciplinary action. "I'm going through therapy," he says. "I'm trying to work this out through groups, but the more I try to push it out, it's there. I just don't want to hurt any more. Sometimes I ask myself, 'Is anyone ever going to say anything or is he just going to keep doing this?'